Healthcare Provider Details

I. General information

NPI: 1245497338
Provider Name (Legal Business Name): DARUSH BEHZAD SAMIA R.N.F.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DARI BEHZAD SAMIA R.N.F.A.

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 VIA ADRIAN
SAN CLEMENTE CA
92673-7026
US

IV. Provider business mailing address

39 VIA ADRIAN
SAN CLEMENTE CA
92673-7026
US

V. Phone/Fax

Practice location:
  • Phone: 949-492-3646
  • Fax:
Mailing address:
  • Phone: 949-492-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN489520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: